Study Praises Mass. Health-Care Program

Massachusetts's ambitious program to move toward universal health insurance nearly halved the number of adults without coverage from about 13 percent to 7 percent in the first year after the multifaceted initiative was launched in 2006, a comprehensive survey has found.

More people in the state are getting medical treatment, including preventive care, and residents are paying less on average in out-of-pocket costs, said author Sharon K. Long, an economist at the nonpartisan Urban Institute in Washington, which researches social policy questions.

But as successful as the plan has proven to be in achieving public health goals, it has cost the state as much as a third more than was initially projected, and about 86,000 taxpayers paid fines for not signing up for health insurance. The program imposes penalties on people who do not buy coverage when they can afford to do so.

Long's report also said some people had trouble finding medical providers and getting appointments, which could be because of increased demand for those services, a shortage of primary care doctors or the newly insured's unfamiliarity with the system.

"It is by and large quite successful and a very strong first year under health reform," said Long, whose study about of health coverage among working-age adults was published yesterday in the journal Health Affairs.

The economist said that the hurdles in finding doctors had been more than offset by the broader coverage, lower out-of-pocket costs and better access to preventive services. Some cost overruns, she added, reflected the program's success in rapidly getting large numbers of people insured.

The plan's measures included offering free insurance to the very poor and subsidized coverage to many others. Incentives and penalties were built in to encourage employers to participate -- Long's study showed that the reform package did not cause them to stop offering health insurance, an early concern.

Brian Rosman, research director at Healthcare for All, an advocacy organization that pushed for the Massachusetts program, acknowledged that the state had to appropriate about $153 million more than the $469 million budgeted for the first year -- a 33 percent increase. He argued that the initial estimates had been conservative and that the state is actively considering ways to offset the costs, perhaps through higher co-payments.

"Nobody knew what this was going to cost in the beginning," he said.

The Massachusetts initiative has been closely watched by other states, the federal government and the presidential candidates.

One of its most contentious aspects involved the fines on those not signing up for coverage -- based on the idea that uninsured people who need care effectively impose costs on the system that are shared by everyone.

Massachusetts Department of Revenue spokesman Robert R. Bliss said the fines raised $9.7 million as taxpayers self-assessed the penalties on their income tax returns. The size of the fines will grow in subsequent years, which could induce more people to decide it is cheaper to pay for the insurance than to continue paying the penalties.

Long said greater efforts are needed to target two groups, including people who are not poor enough to qualify for subsidized care but cannot afford insurance. The other group is "the young-invincible -- the people who think they are young and healthy, and don't need coverage."